Provider Demographics
NPI:1154307965
Name:FAMILY CHIROPRACTIC OF THE QUAD CITIES LTD
Entity Type:Organization
Organization Name:FAMILY CHIROPRACTIC OF THE QUAD CITIES LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:RANDALL
Authorized Official - Middle Name:T
Authorized Official - Last Name:RAMSEY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:309-755-0200
Mailing Address - Street 1:640 15TH AVE
Mailing Address - Street 2:
Mailing Address - City:EAST MOLINE
Mailing Address - State:IL
Mailing Address - Zip Code:61244
Mailing Address - Country:US
Mailing Address - Phone:309-755-0200
Mailing Address - Fax:309-755-0659
Practice Address - Street 1:640 15TH AVE
Practice Address - Street 2:
Practice Address - City:EAST MOLINE
Practice Address - State:IL
Practice Address - Zip Code:61244
Practice Address - Country:US
Practice Address - Phone:309-755-0200
Practice Address - Fax:309-755-0659
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-22
Last Update Date:2008-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL08132044OtherBLUE CROSS BLUE SHIELD
IA1958223Medicaid
IL205405Medicare PIN